increased funding just before Christmas of 1971. Some enthusiastically expected that it would come to a swift and successful end. To complicate matters, however, the war had a series of commanders, each adding his or her own perspective to the overall strategy and how it should be implemented. Despite warnings to the contrary, it appeared reasonable for some to assume that if there were enough money and sufficient commitment, scientists could quickly solve this problem, at least by the 200th anniversary of the founding of the nation in 1976. After all, scientists had developed the atomic bomb and had successfully landed a man on the moon. There was no quick result, however, in the War on Cancer.

What did happen in 1976 was a revolution in thinking about cancer genes. That revolution was triggered by a publication in the journal Nature by Stehelin, Varmus, Bishop, and colleagues (Stehelin et al., 1976). It was the beginning of the concept that a gene from a normal cell could be converted to a cancer-causing gene. The significance of this fundamental finding was not fully appreciated until later. Rather, the expectation of quick results continued, and might have been strengthened when NCI announced the goal of reducing the incidence of cancer by 50 percent by the year 2000.

Mechanisms of Development of Cancer

Although the Panel of Consultants had placed great emphasis on a national plan, such planning was contrary to the tradition of the National Institutes of Health (NIH), which had always acted on the basis that the greatest progress occurs when independent investigators are allowed to pursue their interests. Many argued that research could not be planned at all, and in the case of cancer, about which so little was known, directed research would have been inappropriate. It would be better for the Institute to focus on understanding the underlying mechanisms of the development of cancer. To make matters worse, some of the demonstration programs were premature and did not yield the expected results. They did, however, demonstrate that the Institute did not know how to effect change among either practicing physicians or the lay public. As a result, NCI placed most of its emphasis on doing and supporting what it does best: basic research.

There was a period when the overwhelming evidence for the relationship between tobacco and lung cancer was known but the mechanism of the development of cancer was not understood. Until then there was a struggle between those who believed that cancer was caused by environmental exposures to carcinogens and those who believed that the cause was a viral infection. To add to the confusion, the tobacco industry and its supporters did not accept the ''environmental exposure" concept. Later

Citation Manager

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1 The Struggle Against Cancer ."
The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved . Washington, DC: The National Academies Press,
1999 .